Lateral Lymph Node Metastases in T1a Papillary Thyroid Carcinoma: Stratification by Tumor Location and Size

Abstract

ObjectiveTo analyze the incidence and risk factors for lateral lymph node metastases (LNMs) in T1a papillary thyroid carcinoma (PTC) with a focus on tumor location and size.Materials and MethodsThe incidence of lateral LNM in 345 cases of T1a PTC was retrospectively analyzed. Univariate and multivariate analyses were performed to assess the relationships between lateral LNM and clinicopathological characteristics.ResultsThe incidence of skip metastasis to lateral LNM in T1a PTC located in the upper lobe was 12.1% (8/66). Logistic regression analysis indicated tumor size >5 mm (OR = 5.04, 95% CI = 1.79 to 14.18, P = 0.002), upper lobe location (OR = 7.68, 95% CI = 3.05–19.34, P < 0.001) and the number of central neck LNM (<2: OR = 24.79, 95% CI = 8.23–74.60, P < 0.001; ≥2: OR = 4.99, 95% CI = 1.95–12.73, P < 0.001) were independently associated with lateral LNM. Comparing the lateral and central LNM stratification based on tumor location revealed that both the incidences of lateral (33.3%) and central (30.3%) LNM of T1a PTC located in the upper lobe were higher than those of T1a PTC located in the middle and lower lobes. Of T1a PTC located in the upper lobe, the incidence of lateral LNM was 33.3% (22/66), which was higher than that [30.3% (20/66)] of central LNM. This finding is reversed in all T1a PTC cases and T1a PTC cases with tumor located in the middle and lower lobes.ConclusionA particularly high likelihood of lateral LNM was observed in T1a PTC patients with tumor located in the upper lobe of the thyroid gland, especially the tumor >5 mm in size, which could be considered a risk factor for lateral LNM in the clinical management of T1a PTC.

Predictors of Malignancy in Thyroid Nodules Classified as Bethesda Category III

“…Nuclear atypia has been widely analyzed for its reliability in predicting malignancy in AUS/FLUS nodules. Lim et al (13) The BRAF V600E mutation is the most common genetic alteration in thyroid cancer, it could even occur in 82.0% of T1a PTCs (25). Suh et al (9) reported that the BRAF V600E mutation was the second most influential independent predictor of malignancy in AUS/FLUS nodules and if combined with the Korean Thyroid Imaging Reporting and Data System, it could reduce unnecessary surgeries.…”

“…The BRAF V600E mutation is the most common genetic alteration in thyroid cancer, it could even occur in 82.0% of T1a PTCs ( 25 ). Suh et al.…”

Features of Lymph Node Metastasis and Structural Recurrence in Papillary Thyroid Carcinoma Located in the Upper Portion of the Thyroid: A Retrospective Cohort Study

“…Several researchers have focused on the association between tumor location and the region of LNM ( 16 , 17 ), indicating that the upper portion of the thyroid could be a vital risk factor for lateral LNM (LLNM) in PTC patients. However, what caused us to think was, when we only focused on the upper portion PTC, which risky group of these patients would suffer LLNM and would they have a higher risk of recurrence.…”

The Role of Prophylactic Cervical Lymph Node Dissection with Total Thyroidectomy in Prevention Recurrence of Papillary Thyroid Carcinoma

“…In general, distribution of PTC is more in female gender 25 (61%) and age group <55 years old, 30 (73.2%) in this study as compared to other study are predominant female gender and younger age group from 20-55 years [23]. However, ATA instructions, patients who have tumor stage T3 or T4 with negative cervical lymph nodes metastasis, need prophylactic central cervical lymph node dissection [17] and FNA is indicated when size of thyroid nodules ≥1 cm to diagnosis the thyroid cancer or can used when size of thyroid nodules <1 cm in association with extrathyroid invasion or probability LLN metastasis [24] as involves in the present study. Furthermore, surgical removal of central lymph nodes is obligatory in patient with PTC who has lateral LN metastasis to preclude cancer recurrence and skip metastasis [13].…”